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Medical students and their supporters have been running a very active social media campaign around the #interncrisis.

They’ve also established a website telling the stories of medical students who’ve been unable to get an internship.

We haven’t heard nearly so much, however, about the problems facing other sections of the health workforce, especially nurses. The most recent annual reportfrom Health Workforce Australia makes clear that there are plenty of other supply and demand concerns.

As the chairman of HWA, Jim McGinty, wrote in the report’s introduction:

“We also learned that without reform of the national training system for doctors there will be insufficient specialist training places for medical graduates by 2016. In the case of nurses, short-term supply is relatively stable, but by 2025 there could be a significant shortfall of almost 110,000 nurses if policy settings remain unchanged.”

The report also notes:

“In 2011, there were more new graduate nurses and midwives than suitable graduate positions available in public hospitals. Retaining the skills of these Australian-trained graduates in the wider health system is vital to meet projected nursing workforce shortages in the medium and longer term.”

Meanwhile, in the article below, Professor Bruce Robinson, the Dean of the Sydney Medical School at the University of Sydney, says the lack of intern positions will damage the international reputation of Australia’s medical schools.

Clearly, there will also be financial consequences for universities. And the students will pay the costs of our mish mash of an education and training system rent by “a strife of interests”.

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No resolution in sight

Bruce Robinson writes:

As most will be aware, a large number of international medical students graduating from this and other Australian universities do not have an intern position for next year. I wanted to send this letter to all members of faculty and alumni because we are at a critical point. It is important that all know the situation and understand the consequences of the current standoff.

At the moment, about 150 medical graduates of Australian universities do not have an internship for next year. The largest group is in NSW where 90 or more students do not have positions to go to. It is not just graduates of this University who are without places – in NSW, graduates from University of NSW, Wollongong and Newcastle are also unplaced.

Queensland and Western Australia also have significant groups of students without internships. Victoria has placed the majority of its international students but at the expense of domestic intern numbers, resulting in Victorian students looking for places in other states and receiving them ahead of our international students.

If graduates cannot secure an internship locally, they will have no option but to take their chances in the competitive matching programs in their home countries. In some home countries, there are no opportunities. In Canada, US and European Union, the odds are against them.

I don’t have to emphasise the poor outcome if our students/graduates/soon-to-be-alumni do not secure internship places.

The damage to the reputation of New South Wales as a higher education destination is one thing – and I have no doubt our reputation will be damaged and future international student numbers will be affected. Students will continue to use both the local and international media to tell their stories.

In my view, though, reputational damage is less important than the personal consequences for the students, young people who have come here in good faith, worked hard, passed their exams, become alumni of this (or other Australian) university – but now may potentially find the whole exercise was a waste because they have limited opportunities to get their registration.

We are still hopeful that a satisfactory outcome can be achieved but at the moment, internship appears to have become another political football with negotiations and discussions going back and forth between Canberra, state governments and medical school deans, with no resolution.

Over the past several years, we and other medical schools have argued that international students add a great deal to Australian medical education and community. To run through the main arguments again:

1. International student fees fill funding holes. Medical education is not fully funded, international medical students bring more than $15 million a year into this university alone. That is a lot of salaries and training, which will not be paid for if we don’t resolve this issue.

2. The 847 international medical students attending universities in NSW contribute the best part of $85 million a year to the state’s economy in university fees and living expenses.

3. Across Australia, we have a shortage of doctors and recruit internationally to fill workforce gaps. Last year, like most recent years, more than 3000 visas were issued to international doctors to work in Australia. It is nonsensical to reject graduates of our own universities when we are advertising widely for both junior and senior doctors.

4. In its recent workforce planning report, Health Workforce Australia identified the reliance on internationally trained doctors as a significant area of risk for Australia. HWA has factored into its workforce planning that 70% of international graduates remain in Australia, so we need to find a way to include them and support them in their training.

5. There is capacity for more interns to work in public and private settings. We know that many public hospitals would greatly appreciate additional interns. We know that many interns do a great deal of overtime and in discussions have said they would prefer to reduce their working hours. Increasing the number of interns and reducing the working hours of others would be more productive, potentially safer, and may actually not require significant additional funds. There is also capacity outside the public hospital system to employ interns.

Medical Deans Australia and New Zealand has been pushing hard to find a resolution and all medical schools have agreed on the need for change to the management of international medical students, including caps on the total number and other points.

The Department of Health and Ageing has put $10 million on the table to avert a crisis with this year’s graduates but that money is contingent on the states contributing a total of about $8 million in addition (approx. $4 million in NSW) for all students to secure a place for 2013.

At this point, we have not been able to engage with NSW Ministry of Health and there is no commitment to provide the additional funds that would allow this year’s graduates to secure positions.

Internships for 2013 are the immediate priority, but clearly this is something that needs to be resolved for the longer term.

All parties will need to work together to achieve fair management of this matter. We all appreciate that NSW has funded an increase in intern places, and that the states generally have had to carry additional costs associated with the rising numbers of medical students and new graduates.

I am hopeful that members of faculty and alumni will be able to assist us to secure a better deal for our graduates. Anything you can do, whether it is to raise the issue with your local parliamentary representatives or with the NSW Minister for Health or in other ways, would be greatly appreciated.

One of the questions I have been asked is whether international graduates have the support of domestic students, suggesting the local students may be more concerned about the training bottlenecks ahead. That is not the impression I have had from any of our domestic students, and the recent rally in Taylor Square in Sydney was well supported by international and domestic students.

4 thoughts on “Intern crisis is damaging us internationally (but what about the wider health workforce concerns?)”

You make an unjustified and somewhat odious extrapolation. Nowhere do I say ‘hate’ nor state, nor imply that I dislike foreign students nor that I hold antipathy towards people with an education. Your baseless imputation is rejected utterly.

My objection to the arguments advanced is an objection to the view that the entitlement you feel should over ride any other public policy consideration and the cloaking or confusion of this self interest with the medical needs of the Australian population.

1 – You are factually incorrect. You are ‘able’ to pay. The evidence for this is that you do pay. We all make decisions about how to use our money and you made yours. To talk about your income upon qualifying is specious. The lifetime benefit of your degree will be substantial and – lets be honest – one of the reasons you chose medicine. You do not deal at all with the issue of how much money the state should continue to pour into internship training or whether at some point this use of tax dollars should have a limit. Is this not an important question?

2 – If your enrolling university guaranteed you an intern place, I suggest you take steps to hold them to that promise. If they sold you a product knowing they were unable to deliver, I suggest you take action to recover your loss. If you didn’t make adequate enquiries about the course being offered then you only have yourself to blame. Caveat emptor?

As a digression I note your point that you choose to come here where you thought or assumed that an internship was guaranteed rather than go to the States and compete for one on ‘merit’.

3 – I simply can’t respond because this doesn’t make sense. You make no comment on the sustainability of the system. To reiterate my original point, the ‘system’ does not have unlimited capacity to provide training places.

Dear SBH,
Outrage? No, we don’t feel that. Your opinion on this matter was something we expect. It is attractive, I know, to hate the so-called “elite”. I understand how you feel, but please allow me to comment on your points, one by one.

1. We are not, by any means, people “able” to pay these substantial sums of money. I, and I know of few colleagues who do share this situation, have taken a 400 000$ loan against my parents’ house; a second mortgage. Most of us were, sadly, not members of the “upper-middle class”. At the completion of our degree here, in fact, we are financially several “classes” lower.

2. We did not come here with this knowledge; at the very least we were misinformed. Medical degrees in Australia are marketed very aggressively in Canada. No, I do not have anything in writing which says I am guaranteed an internship, but this was most enthusiastically implied. If it were not, we all would have gone to medical school in the United States, where internships are granted by merit, and not by nationality.

3. Regarding capacity – have you ever been to a private hospital? Or to a rural hospital?

In conclusion, you may not like us because we are foreign, or maybe because we are highly educated. But do not confuse us with people that are privileged, or with people that aren’t devoted to the health and well-being of Australians like you.

1 We are talking about people able to pay substantial amounts of money to undertake the premier tertiary course offered by universities. The outcome for these students will be a lifetime of significantly higher earnings than the average. Why does it follow that the state should continue to provide uncapped support for this activity. It can’t and shouldn’t. The ‘rent seeking’ side of this argument is under-developed.

2 International students choose to come to Australia to study in full knowledge that intern places are limited. If they don’t know that then their enrolling university has sold them a pup. It’s a bit rich for international students to sign up for a course, knowing they only have a 2:3 chance of getting an intern place and then complain that Australia at large is letting them down. A useful question might be why they didn’t choose to study at home?

3 What capacity is there in the system? Nationally, the number of graduates increased from 1,633 in 2006 to approximately 3,500 in 2012. There are about 3,065 intern training posts in 2013 for 3,253 applicants (2,855 domestic students and a further 398 international students). Is this rate of growth sustainable and will it continue to produce the level of competent professionals we need?

It is simply dishonest to frame this issue as the answer or partial answer to our doctor shortage. It is an argument about self interest and an attempt to manipulate a system you didn’t like but agreed to be part of. International students knew what they were getting when they signed up and the addition of this number will not solve Australia’s long-term heath workforce needs.